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Randomized evidence supports ultrasound-indicated cervical cerclage for selected women with a prior spontaneous preterm birth who develop a markedly shortened cervix during the midtrimester. The benefit is not universal and depends on the clinical phenotype, making serial transvaginal cervical-length assessment particularly valuable in high-risk pregnancies. For obstetricians, the decision should integrate prior obstetric history, gestational age, cervical length, membrane status and the absence of labor or infection. Cerclage is one component of a broader prevention pathway that may also include progesterone and close surveillance.
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Randomized evidence supports ultrasound-indicated cervical cerclage for selected women with a prior spontaneous preterm birth who develop a markedly shortened cervix during the midtrimester. The benefit is not universal and depends on the clinical phenotype, making serial transvaginal cervical-length assessment particularly valuable in high-risk pregnancies. For obstetricians, the decision should integrate prior obstetric history, gestational age, cervical length, membrane status and the absence of labor or infection. Cerclage is one component of a broader prevention pathway that may also include progesterone and close surveillance.
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